Lecture 4 - Contraception Flashcards
Sponge info
1 time use
insert 24hrs before, leave in for at least 6, no more than 30 hrs
OTC
Diaphragm info
plastic, reusable and lasts 2 yrs
have to fit it with provider and use w/ spermicide
its RX
Cervical Cap info
used up to 2 yrs
used combo w/ spermicide
its RX
Conditions when estrogen is not preferred?
Migraine headaches
> 35yrs old and smoker/obese
History of thromboembolic disease
Cardiac disease, CAD or HF
Cerebrovascular Disease
Hypertriglyceridemia
HTN + vascular disease or > 35yr old
What does Phasic Mean
Mono = same estrogen/progestin each pill
Bi = same estrogen, progestin inc about half way
Tri = hormones change every 7 days
Conventional vs extended cycle
21 active + 7 inactive
or can do active nonstop or 84days active/ 7 inactive
Estrogen Dosing & SE
30mcg = normal
higher doses = more SE, forgiving dosing, less bleeding
Lower = less SE, less forgiving dosing, more bleedings
Progesterone Dosing & SE
Earlier gen = more androgenic (less clotting and more SE)
Later Gen = more estrogenic (less term SE, more Estrogenic SE)
Counseling points for Birth control
same time every day
at night w/ food if N/V occurs
Managing missed pills
When to start
Starting methods
Quick = start use back up for 7 days
Sunday = start 1st Sunday after menses and backup for 7 days
1st day start = start on day 1 menses, no backup needed
Managing Early breakthrough bleedings
days 1-9
switch to higher estrogen or switch to multiphase pill with higher estrogen in beginning of cycle
Managing late breakthrough bleeding
days 10-21
Switch to higher progestin or switch to multi phasic pill w/ high progestin dose at end of cycle
DI w/ Birthcontrol
Anticonvulsants
NNRTIs
Protease inhib
ABX = rifampin
How to counsel if late/miss pill
< 24hrs = take as soon as possible and continue rest usual time
if miss > 2 pills, start on back up contraception
Progestin only pills
“mini pills”
used for pts on inc clot risk
migraines
lactating women
Has to be taken same time each day
Progestin only pills, what to do if miss
< 3 hrs, take asap
> 3 hours, use backup for 2 days
Drosperinone = improved missed dose time
IUD Menses SE Cooper vs LNG
Copper = longer and heaver menses, more crampign
LNG = spotting in 1st 6 months, amenorrhea
copper preferred in pts who dont want hormones used
IUD SE
Common = ab pain, Fatigue, HA, Dizziness, breast tender, nausea
Rare = Expulsion of IUD, perforation cervix/uterus, infections
Implant Birthcontrol
Nexplanon
Good for 3yrs (5 yrs off-label)
SE = irregular bleeding, mood change and weight gain
put in by provider
Injectable Birthcontrol
DepoProvera
done every 3 months
Given IM or SubQ
SE = irregular bleeding, weight gain, osteoporosis risk = take with Vit D/calcium
back up 1st 7 days after 1st, or if more than > 15 weeks since injection (so miss 3 month mark)
Transdermal Patch Birthcontrol
Xulane, Twirla
1 patch QW for 3 weeks, then 1 patch free week
Decreased efficacy if BMI > 30
Safety = inc exposure to estrogen
Vaginal Ring Birthcontrol
Nuvaring = brand = every 3 weeks
EluRyng = generic
Annovera = can be reused for 1 year
Less N/V than other options
Safety = Amy inc vag secretions and irritation
When is progestin only products or Copper IUD recommended
> 35yrs old +
BMI > 30
DM
Uncontrolled HTN
Smoker
Migraines
Immobile
if pt experience Aura with Migraines then they are….
at inc risk go stroke = Progestin ONLY
if no aura = estrogen OK
Emergency Contraception eligibility criteria
child-bearing age who experienced these events in last 120hrs….
unprotected sex
contraceptive failure
sexual assault
repeated use of EC doesn’t make someone ineligible
LNG emergency contraceptives how it works
used to prevent fertilization and implantation
effectiveness wanes over time**
most effective up to 72hrs
LNG emergency contraceptives info
OTC
efficacy dec those who weight > 165lbs or BMI > 25
given as one dose ASAP
Ella MOA & info
inhibit/delay ovulation
** Effectiveness doesn’t decrease over time**
Selective progesterone receptor modulator
take within 5 days, and can use BMI > 25, but efficacy decreases > 35
Emergency Contraceptives IUD
Paragard = copper IUD
has to be inserted 5 days after sex and 99% effective
Counseling for EC
if vomit within 2-3 hrs, repeat dose
Won’t protect against HIV/STI
If menses > 1 week late…take a preg test
Take the drugs ASAP, pref within 72hrs
Obese pts special info
Progestin only if BMI > 25
Ella (Ulipristal Acetate) can be used BMI 25 -35
Copper IUD if > 35 BMI
